Minimally invasive partial or total nephrectomy in children: a comparison between transperitoneal and retroperitoneal approaches.

ABSTRACT

INTRODUCTION AND OBJECTIVES: We present data from a single surgeon experience of paediatric transperitoneal (TP) and retroperitoneal (RP) minimally invasive approaches for partial (PN) and total nephrectomy (TN). METHODS: A retrospective review was conducted in the patients undergoing nephrectomy between 2003 and 2008. Patients were divided depending on PN or TN and the approach (RP or TP). Primary outcome was the need to convert to an open procedure. Secondary outcomes included operation time, length of stay (LOS) and complications. Statistical analysis included Fisher's exact test. RESULTS: 68 patients underwent minimally invasive TN/PN, 49 (72%) RP versus 19 (28%) TP. There were no differences between the groups in terms of sex, age, pathology, LOS, complication rate and conversion rate. Neither group recorded mortality. Conversion occurred because of difficult anatomy or the kidney size rather than an adverse event. Overall, there was no difference in operative time between the RP and TP. This was also the case for TN only. However, the PN subgroup demonstrated a decreased operative time with RP (p = 0.049) possibly due to better anatomical delineation. There were no complications. CONCLUSIONS: Minimally invasive TN or PN can be performed via retroperitoneal or transperitoneal routes with minimal morbidity. With training, PN via retroperitoneal approach can be achieved with significantly reduced operative time.